Prof Julie Leask spoke about risk communication at the recent Asia Pacific Immunization Coalition’s conference in Singapore.
News
New publication by SABII members + colleagues
A new Perspective piece titled Is it time to retire the label “CALD” in public health research and practice? was published last week in the Medical Journal of Australia. It was led by SABII team member Ikram Abdi, and co-authored with Adeline Tinessia (SABII), Abela Mahimbo (UTS), Meru Sheel (IDIE) and Julie Leask (SABII).
Writes Dr Ikram Abdi, “Whilst “CALD” was originally intended to capture diversity in Australia, it often obscures important differences, reinforces othering and may influence programs and policies in ways that don’t always serve the communities it aims to represent.
This isn’t a new conversation. It’s been ongoing across many sectors, with growing calls to move away from the “CALD” label. Our think piece adds to this dialogue by highlighting the need for precise, accurate language in public health. Whilst there’s no single solution, being intentional with our words is crucial, as language shapes how we understand and address inequities.”
Is it time to retire the label “CALD” in public health research and practice? doi.org/10.5694/mja2.52608
Introduction below, click the links to read the full piece.
In Australian public health research and practice, the label “culturally and linguistically diverse” (CALD) is used to encompass a diversity of birth countries, languages and cultures. This term is routinely used in public health to address diversity, to guide equitable access to health resources, and inform inclusive policies and programs. It influences how health research and services are designed and implemented. However, the label has inherent limitations, and its broad application simplifies and masks disparities within these diverse communities. As researchers, like many others, we have also used the label “CALD” as a form of acknowledgement of diversity in Australia. This perspective article challenges the use of the label, recognising its use in current research and practice, while also exploring the need for a more nuanced approach.
Click here to read the full Open Access article: Is it time to retire the label “CALD” in public health research and practice? doi.org/10.5694/mja2.52608
New publications
In a recent analysis paper published in BMJ Global Health, Majdi Sabahelzain and Julie Leask from SABII, along with Harriet Dwyer (LSHTM) and Seye Abimbola (SSPH), analysed vaccination coverage and the trend of polio and measles outbreaks in five countries affected by conflict in the Sahel Region of Africa: Burkina Faso, Chad, Mali, Niger, and Sudan. The study reveals that ongoing conflicts lead to more children missing vaccinations and an increase in polio outbreaks caused by vaccine-derived poliovirus and measles in these countries. Health insecurity in the Sahel region is highlighted by the emergence of genetically linked polio variants, primarily due to the mobility of nomads and displaced and refugee populations who might be un or under-vaccinated. The paper also suggests using diplomatic strategies and investing in creative methods to help reach vaccination programs in hard-to-access areas.
In December, Majdi Sabahelzain presented some of his research into zero-dose children in conflict during Gavi’s Zero-Dose Learning Week Post-Event Webinar went live last December on YouTube.
Happy Holidays!
Last week the SABII team and colleagues from NCIRS enjoyed an end-of-year lunch at the pub. Here are a few snaps of the team. It’s rare to have so many of us together in one place!
As another busy and successful year winds to a close, the SABII team would like to wish everyone a safe, restful and happy festive season. See you in the new year!
Congratulations!
Congratulations to two of SABII’s team members who recently graduated, Dr Maria Christou-Ergos and Dr Belinda Bruce, pictured below with their supervisors Dr Kerrie Wiley, Prof Julie Leask and A/Prof Heather Shepherd. Also credit to A/Prof Brad de Vries, who also supervised Belle.
Dr Bruce’s thesis is titled: An examination of the administration of intravenous fluids to women during labour. Dr Christou-Ergos’ thesis is titled: Understanding vaccine hesitancy in relation to psychological trauma. Some of their findings can be found in the papers below:
- Bruce BR, Shepherd HL, Khan SA, Haunton CR, Leask J, De Vries BS. Association between intravenous fluids during labor and primary postpartum hemorrhage: A retrospective cohort study. Acta Obstetricia et Gynecologica Scandinavica. 2024;103:1541-9.
- Bruce BR, Leask J, De Vries BS, Shepherd HL. Midwives’ perspectives of intravenous fluid management and fluid balance documentation in labour: A qualitative reflexive thematic analysis study. J Adv Nurs, 79:749-761
- Bruce BR et al, The administration of intravenous fluids to nulliparous women in labour: A retrospective clinical chart review and fluid balance documentation audit, Collegian, 2022-06-01, Volume 29, Issue 3, Pages 364-369.
- Christou-Ergos, M., Wiley, K. E., & Leask, J. (2023). Association between traumatic life events and vaccine hesitancy: A cross-sectional Australian study. Public Health (London).
- Christou-Ergos M, Leask J, Wiley KE, (2022) Willingness to receive a vaccine is influenced by adverse events following immunisation experienced by others, Vaccine.
- Christou-Ergos M, Wiley KE, Leask J, Shapiro GK. (2022) Traumatic Events and Vaccination Decisions: A Systematic Review. Vaccines.
- Christou-Ergos M, Leask J, Wiley KE. How the experience of medical trauma shapes Australian non-vaccinating parents’ vaccine refusal for their children: A qualitative exploration, SSM-Qualitative Research in Health.
National Vaccination Insights project
The SABII team have been involved in the National Vaccination Insights project which surveyed a nationally representative cohort of 2,000 parents. The aim of the study was to understand the barriers to uptake of National Immunisation Program vaccines among children under 5 years of age.
The researchers have worked closely with the World Health Organization to adapt, pre-test and validate the Behavioural and Social Drivers (BeSD) of vaccination survey, which is being developed to support global efforts to better understand the drivers of adult flu vaccination.
A pre-print of the paper is available here: The Drivers of Influenza Vaccination in Adults: Insights from a National Australian Survey.
ABSTRACT
Influenza vaccination coverage is suboptimal in the Australian adult population. While coverage data is used to monitor uptake, at present, there is no systematic data collection on the behavioural and social drivers of vaccination. This study used a globally standardized survey tool to measure constructs related to influenza vaccination within four domains (i) vaccination-related thoughts and feelings, (ii) social processes, (iii) motivation, and (iv) practical issues.
An online survey was administered to a sample of 2055 Australian adults recruited via an online panel in March 2024. Logistic regression analysis was used to determine factors that contributed to people’s intention to receive an influenza vaccine.
Most Australian adults (62.8%) wanted an influenza vaccine in the upcoming influenza season. The odds of wanting an influenza vaccine were significantly greater for people who: had received an influenza vaccine in the preceding two years (aOR:10.35; 95% CI: 7.09-15.11) p<.001; thought the influenza vaccine offered personal protection (aOR:2.66; 95% CI: 1.76-4.01) p<.001; thought the influenza vaccine offered protection to others (aOR:1.6; 95% CI: 1.08-2.39) p=0.02; thought the influenza vaccine was important for their own health (aOR:1.53; 95% CI: 1.03-2.27) p=0.04; felt a social responsibility to get an influenza vaccine (aOR:4.05; 95% CI: 2.88-5.68) p<.001; believed close family and friends wanted them to get the influenza vaccine (aOR:2.35; 95% CI: 1.67-3.3) p<.001; believed community leaders wanted them to get the influenza vaccine (aOR:1.48; 95% CI: 1.08-2.01) p=0.01; received a recommendation to get the influenza vaccine from a health care worker in last two years (aOR:1.7; 95% CI: 1.24-2.32) p<.001.
This study provides a foundation for ongoing national monitoring of the drivers of influenza vaccination. This will help tailor timely strategies to population needs. Strategies that increase confidence in the value of vaccination, foster positive social norms within communities and increase access to vaccine services may help increase influenza vaccine acceptance.
Christou-Ergos, M., Sabahelzain, M. M., Steffens, M., Kaufman, J., Bolsewicz, K.T., Danchin, M., and Leask, J., The Drivers of Influenza Vaccination in Adults: Insights from a National Australian Survey (August 26, 2024). Available at SSRN: https://ssrn.com/abstract=4958283 or http://dx.doi.org/10.2139/ssrn.4958283
SBS reported on the study and also interviewed SABII’s Dr Ikram Abdi: The Australian vaccination trend some fear could be a ‘canary in the coal mine’.
Sydney Peace Prize panel
Last week, Dr Majdi Sabahelzain, one of our SABII team, participated in a panel discussion on Delivering Healthcare and Protecting Civilians in Conflict Zones. Other panellists included Professor Catherine Renshaw, Dean of Law, Western Sydney University, Mr Jagan Chapagain, Chief Executive Officer and Secretary General, International Federation of the Red Cross and Red Crescent Societies, and Professor Emily Crawford, Professor, Sydney Law School. The University of Sydney. The discussion was moderated by Dr Megan Cox, Senior Lecturer at SSPH.
The discussion explored the ethical and practical challenges faced by healthcare workers in delivering impartial care amidst large-scale displacement, conflicts involving non-state actors, and protracted crises. It also highlighted the alarming frequency of human rights violations, particularly the attacks on health facilities and healthcare workers, and emphasised the need to abide by the international humanitarian law (IHL) in protecting not only civilians and healthcare providers but also wounded and sick combatants.
Dr. Majdi Sabahelzain highlighted the inequities in media coverage of crises, particularly in protracted conflicts and civil wars in countries that hold low geopolitical importance for donors. Mr Jagan Chapagain discussed further how this disparity affects global attention and results in insufficient support and resource allocation for crises in underreported regions.
The event was part of the annual Sydney Peace Prize, awarded this year to the International Federation of Red Cross and Red Crescent Movement. The event was hosted by the University of Sydney’s Faculty of Medicine and Health, in partnership with Sydney Peace Foundation, Sydney Law School, and Western Sydney University, with guests from the Western Sydney Local Health District and International Red Cross and Red Crescent Movement.
Professor Catherine Renshaw, Dr Megan Cox (moderator)
New pre-prints from the SABII team
Check out two new pre-prints from the SABII team, led by Dr Christou-Ergos. See the abstracts below, and click the links to see the full articles.
Christou-Ergos, Maria and Sabahelzain, Majdi M. and Steffens, Maryke and Kaufman, Jessica and Bolsewicz, Katarzyna T. and Danchin, Margie and Leask, Julie, The Drivers of Influenza Vaccination in Adults: Insights from a National Australian Survey (August 26, 2024).
Abstract
Influenza vaccination coverage is suboptimal in the Australian adult population. While coverage data is used to monitor uptake, at present, there is no systematic data collection on the behavioural and social drivers of vaccination. This study used a globally standardized survey tool to measure constructs related to influenza vaccination within four domains (i) vaccination-related thoughts and feelings, (ii) social processes, (iii) motivation, and (iv) practical issues.
An online survey was administered to a sample of 2055 Australian adults recruited via an online panel in March 2024. Logistic regression analysis was used to determine factors that contributed to people’s intention to receive an influenza vaccine.
Most Australian adults (62.8%) wanted an influenza vaccine in the upcoming influenza season. The odds of wanting an influenza vaccine were significantly greater for people who: had received an influenza vaccine in the preceding two years (aOR:10.35; 95% CI: 7.09-15.11) p<.001; thought the influenza vaccine offered personal protection (aOR:2.66; 95% CI: 1.76-4.01) p<.001; thought the influenza vaccine offered protection to others (aOR:1.6; 95% CI: 1.08-2.39) p=0.02; thought the influenza vaccine was important for their own health (aOR:1.53; 95% CI: 1.03-2.27) p=0.04; felt a social responsibility to get an influenza vaccine (aOR:4.05; 95% CI: 2.88-5.68) p<.001; believed close family and friends wanted them to get the influenza vaccine (aOR:2.35; 95% CI: 1.67-3.3) p<.001; believed community leaders wanted them to get the influenza vaccine (aOR:1.48; 95% CI: 1.08-2.01) p=0.01; received a recommendation to get the influenza vaccine from a health care worker in last two years (aOR:1.7; 95% CI: 1.24-2.32) p<.001.
This study provides a foundation for ongoing national monitoring of the drivers of influenza vaccination. This will help tailor timely strategies to population needs. Strategies that increase confidence in the value of vaccination, foster positive social norms within communities and increase access to vaccine services may help increase influenza vaccine acceptance.
Leask, Julie and Christou-Ergos, Maria and Abdi, Ikram and Mbossou, Franck and Sabahelzain, Majdi M. and Wiley, Kerrie and Lambach, Philipp and Sim, So Yoon, Informing the Development of Transmission Modelling Guidance for Global Immunization Decision-Making: A Qualitative Needs Assessment (August 26, 2024). Available at SSRN:
Abstract
In recent years, mathematical transmission models have been increasingly used to support immunization program decisions and to measure the impact and cost-effectiveness of interventions. However, countries face expertise-and resource-related barriers that limit the use and application of modelled evidence to inform decisions. The World Health Organization (WHO) established an Immunization and Vaccines Related Implementation Research advisory committee subgroup in 2023 to support immunization decision-makers to effectively generate, translate and use such evidence for strategies, policies, and programs. This study supports this effort, detailing the needs of end-users to inform content and format of the guidance.
Fifteen in-depth interviews were conducted with vaccination decision-makers and modellers from all WHO regions and across low-,middle- and high-income countries. Interviews explored: (i) how modelling is understood and used; (ii) the challenges faced when using modelled evidence; (iii) the types of guidance that would be most useful to enhance the use of modelled evidence. Analysis of transcripts was guided by the framework method.
Participants with modelling expertise used it firsthand, systematically, and often in an advisory capacity. Less experienced users, often in policy advisory roles, were less confident in their understanding of modelling and some did not use it at all. Decision-makers with little or no modelling experience cited a need for more information to help them understand the value of modelling in their context and many supported its potential. All participants saw a need for capacity strengthening and localised application to instil confidence in using modelled evidence. Those with less experience expressed a need for ongoing interactive engagement with knowledge brokers and training.
Immunisation program review in Timor-Leste
Timor-Leste has succeeded in controlling several diseases, including polio, maternal and neonatal tetanus, and endemic measles and rubella. The country has also introduced several new vaccines in recent years, mostly recently HPV vaccination in a very successful rollout. The Ministry of Health requested a joint national / international review of the Expanded Programme on Immunization and vaccine preventable disease surveillance system in Timor Leste (EPI review). The review also combined a post-introduction evaluation for pneumococcal conjugate vaccine and COVID-19 vaccine. The international review team included: Professor Julie Leask (SPH), Dr Dijana Spasenoska, (WHO HQ), Dr Tondo Opute Emmanuel Njambe and Dr Sigrun Roesel (WHO SEARO), Dr Sarah Sheridan and Dr Ann Burton (NCIRS), Dr Monica Shah and Dr Michael Lynch (US CDC), Dr Jobayer Al Mamum (WHO Bangladesh), Dr Jeffrey Jap (East Nusa Tenggara PHO), Dr Khin Devi Aung (UNICEF EAPRO) and Dr Ratih Oktri Nanda (MoH Indonesia). It was coordinated by the World Health Organization HQ, Regional Office for Southeast Asia, and Timor Leste Country Office.
This was an intense two weeks of fieldwork, debriefing and reporting held from 14th to 25th October. Seven teams comprising international reviewers, Ministry of Health staff, and WHO consultants visited 13 municipalities, 73 health facilities and did 14 national-level interviews. They synthesised findings and recommendations over two days and presented them to the Minister for Health, Hon Dr Élia António de Araújo dos Reis Amaral, her ministry, and key partners.
The review recommended strengthening several areas: staff orientation and supportive supervision, updating and supply of guidelines and forms, waste management, strengthened cold chain monitoring, follow-up of missed children, outreach, coverage assessment, adverse events response, and strengthening the system for working with community volunteers. These build on many strengths, including the commitment and existing expertise of staff throughout the program. Detailed findings of this review will inform the National Immunisation Strategy, 2025-2029.
CDIC 2024
Last week, several of the SABII team presented at the 2024 Communicable Diseases and Immunisation Conference, hosted in Brisbane, Queensland. This year’s theme was Protecting Communities: Empowering Health through Disease Control and Immunisation’.
Rebika Nepali outlines a few of the conference highlights below:
I had such an enriching experience attending the Communicable Diseases and Immunisation Conference 2024, Brisbane. I had the great opportunity to network with many inspiring individuals. Some key highlights from the conference include (my personal experience):
Speaker Tiahni Adamson shed light on “Caring for the country in a climate crisis” with insights from the First Nations community and emphasised how listening to the needs of people is important in decision-making.
As we know 2024 is 50th anniversary of “Expanded Program on Immunisation” EPI, Journey from Smallpox and Polio eradication and prospects for Measles elimination by Professor Peter McIntyre is worth reflecting on.